You’ll be hardpressed to find any area of life that hasn’t changed since the onset of COVID-19. And that includes, pregnancy. With the pandemic looming on, with no end in sight—particularly for the United States—women are thinking seriously about family planning, contraception and delaying having children.
Which means birth control.
We spoke to Dr. Jessica Shepherd, practicing OB/GYN and women’s health expert at the University of Illinois, about the options available to women these days, specifically the hormone-free IUD called the Paragard, what Black women can do to advocate for a safer, healthier pregnancy and delivery, and what we can do to get the most out of our gynecological visits.
MadameNoire: Have your patients expressed concerns about getting pregnant or giving birth in the midst of this pandemic?
Dr. Jessica Shepherd: I think that’s a very valid concern that patients have and should discuss with their doctors. Most pregnancies are “unplanned”—if you want to call it that. But for those who are planning and have those questions, it could require a visit.
MN: In addition to the pandemic, Black women face additional concerns during pregnancy and labor. Do your patients speak to you about these concerns?
Dr. Shepherd: Oh yeah, I think that’s the overwhelming topic—more than just this year. But this year has really made it a discussion topic. The increased maternal mortality rate is a public health issue. It’s all intertwined but I’m glad it’s being discussed more so we can be very open with our intent on how we plan to fix that.
MN: How is childbirth different because of COVID?
Dr. Shepherd: The process is different in the sense that we can’t have more than one person in the delivery room. Many times, if someone is COVID positive, prior to delivery, we have to keep them isolated. And also postpartum if mom is COVID positive, they have to determine the baby’s status before they’ll allow mom to be with baby.
Most hospitals now are testing patients with rapid testing or if they have a c-section or planned induction date, they’ll try and test them about a good 48 hours prior to their admission to the hospital. So these protocols are not always easy to implement because deliveries happen any and every time. But it’s really for the safety of everybody.
Also using PPE wear during delivery, making sure physicians wear eye protection, face shield and the N-95 masks because some people can’t get tested before they start the delivery process if they’re already in labor.
The best way to be preventative is to assume that everyone’s positive.
MN: What do you advice do you offer expectant mothers? It’s a public health issue but it’s not their fault so is there anything you can advise to ensure that they’re able to have a safe pregnancy and delivery?
Dr. Shepherd: There are a few things that I’d highlight. If I could name three specific goals that a woman could do it would be:
- Go to her visit prepared.
Not like people don’t go prepared but now that we know that this is something to be focused on, it’s important to go with concise questions. And find a way to document or record the information that you get. If you need to have that information for later, you have access to it. And you can also share that information with someone else so that they know what they heard was exactly as they heard it.
- Install a patient advocate for themselves
Have a family member, a confidant, a family member, or friend come to visits with them, if that’s possible. Because of the pandemic, that’s less likely but there are telehealth appointments that can be done. There are consults that can be done with family members around. What we see now because of COVID is bringing people into delivery rooms or appointments via FaceTime so that’s a great way that you can have more than one ear open to the information that’s being delivered. So you can ensure that more than one person heard it. And that helps to reiterate the messaging.
A lot of times when we give patients information, it can be misconstrued or misunderstood. So one of the ways of navigating through that is having someone there that can reiterate the message and also make sure that it stays prioritized.
- Ask for a second opinion
Outside of race of the pandemic, I always encourage patients who feel that the relationship they have with their physician—sometimes it’s not always a physician problem or a patient problem. Sometimes it’s a communication problem. The communication can be a little off. So that’s when you can ask for a second opinion or a different provider or going to another specialist. And you really want to make sure that you’re paying attention because one of the things we don’t advocate for or don’t advise is changing care late in the pregnancy. That’s not helpful to anyone because there’s so much time and information that was missed.
And sometimes it can be difficult to determine what needs to be done when you have such a time sensitive process.
MN: For those people who are trying to avoid getting pregnant during this time, how do you ensure that you don’t have a toxic reaction to the birth control that you choose?
Dr. Shepherd: I think one of the things is discussing with your physician prior to having contraceptive counseling is for patients to know what’s in what they’re getting.
Now, the great thing about the Paragard is there is no hormone. It’s a 100% hormone free. So you’re less likely to see what we hear patients referring to when they talk about side effects of contraception. Usually, they’re referring to a hormonal side effect rather than something else. It’s usually due to the active ingredient. And the Paragard only has one active ingredient, (copper) so if there is an issue we would know what caused it.
MN: Can you tell us more about the Paragard? How is it we’re able to have birth control with no hormones?
Dr. Shepherd: The Paragard is one of those forms of contraception that’s been around for a very long time. It’s an IUD. The IUD has been around decades. It’s been so longstanding because it’s reliable. It’s hormone free and maintenance is very low. So, once it’s inserted, it’s completely reversible. It works for a maximum of ten years.
MN: Would you say that women should avoid adding any types of additional hormones to their bodies?
Dr. Shepherd: No, I wouldn’t say that. I think when you look at the world of contraception and what’s available to women—what has been developed over the decades, I think there is absolute need for all forms of contraception, whether they have hormones or not. The availability and the flexibility within our options and choices as women which is the most important.
When you look at how many women are allowed to have that freedom, that should be the take home message.
Yeah, there are going to be a lot of women who don’t respond to hormonal birth control but there are millions of women who use contraception, it doesn’t matter what kind. And that’s the beautiful part about where we are today because prior to contraceptives being developed, women had no options. Like, none. We’ve come a long way and I wouldn’t label it as something that is not good to have.
MN: What about affordability of birth control?
Dr. Shepherd: When you think about affordability, I usually go to my mainstay of Planned Parenthood. But when you think about contraceptive counseling, people have insurance. They have insurance plans. The most important distinction of whether they go to Planned Parenthood or whether they go to the doctor’s office is about what am I looking for? What are my expectations? What have I experienced in the past? And using that as a guideline to narrow down your choices of birth control and what looks best for that person. It’s a very individual decision.
Most people come in after they’ve had an ‘uh oh’ moment and realize they need to be on birth control. But it’s really a conversation that should start early in age. Not that they should start at that time but that they have the information. When you have young women who at least know what’s available so they can make better decisions for themselves.
MN: When can you do a telehealth appointment and when should you go into your gynecologist’s office?
Dr. Shepherd: I think that’s been something that’s changed over the last five months. The telehealth visits can really accomplish more than one would think. I know a lot of people are freaked out like, ‘What?!’ How are you going to do an exam? It’s not so much of the exam but the foundation—with any medical discipline—the basis of the relationship starts in the information room.
That requires a lot of information that needs to be extracted from the patient, starting the discussion. When you look at it from that perspective, you can start the discussion and determine if it’s something that’s urgent and the patient needs to come in right away or two weeks out or maybe they can get their question resolved right then.
In my practice, the top three things I saw patients for on telehealth were abnormal uterine bleeding, contraceptive counseling, and IUDS. So we would do the initial consultation and then bring them in for the insertion.
I saw an increase in IUD patients over this time because people were thinking about things that were longstanding so the features of the IUDS really made a stand out appearance because it has such low maintenance
MN: How can women make sure they get the most out of their gynecological visits? Too often we go into those appointments anxious or scared and then we end up leaving without giving or receiving the information we wanted.
Dr. Shepherd: One of the best features is to come prepared. We all have it in our heads, right and then you get there and then you have some anxiety and then you leave and you’re like, ‘I literally forgot to ask A, B, and C.’ So writing it down is sometimes the best and easiest advice to take.
Now, I would say the challenge is when patients have the expectation that the questions they bring are all going to be answered. That sometimes can fail.
The relationship between a physician and patient should be one that’s ongoing. So the expectation of going and getting twenty questions answered versus we can look at those questions and say let’s tackle the most important ones that are impacting you right now and then let’s do a follow up visit and get to the rest of those questions. Sometimes it’s a part B and part C type of visit.